Congenital heart disease (CHD) is now estimated to be the second most prevalent chronic illness may have effects that pervasive consequence for family life. Recently, focused on resiliency variables, especially support and coping strategy, regulating the impact of stress. In the resiliency model of family stress, adjustment and adaptation, social support is viewed as one of the primary mediators between stress and well-being.

There are six important vital structures in the neck providing aerodigestive, nervous, endocrine, and circulatory functions and they are minimally protected by the skeletal system unlike other areas of the body. This lack of protection in the neck not only contributes to physician angst during treatment, but also to the high mortality and complication rate when injury occurs. Airway compromise and exsanguination are both very high priorities and the time required to deal with one can be to the detriment of the other. Rapidly controlling hemorrhage provides the time required to establish a definitive airway without further blood loss of an already depleted intravascular volume.

Method for Hemorrhage Control

Delays in establishing definitive control of the airway can make the task of subsequent airway control difficult or impossible because of hematoma formation or injury/resuscitation induced edema leading to subsequent catastrophic airway obstruction. The Western Trauma Association (WTA) Critical Decisions in Trauma recommends direct manual pressure (DMP) be used as a first line response to penetrating neck injury. However, this approach has been associated with a low efficacy rate due to re-bleeding and exsanguination prior to reaching definitive operative care.

Intestinal evacuation is a complex sequence of events resulting from the integration of the autonomic and somatic nervous systems and culminating in the elimination of fecal matter contained in the descending colon and rectum. In turn, intestinal habitus is a personal characteristic varying considerably among individuals due to factors such as quality and quantity of ingested food and drink, convenience and a satisfied feeling of well-being, with no discomfort and without the sensation that evacuation was not sufficient.

One of the most common causes of death worldwide is sudden cardiac arrest. Including Europe, United States and Canada, each year 350,000-700,000 people are affected. In US, approximately 350,000 people annually experience an out-of-hospital cardiac arrest, with mortality 92% and according to American Heart Association, 88% of them occur at home. It is well known that expeditious application of cardiopulmonary resuscitation is of major importance. Every time-delay after that has been accused for survival rates fall, with decrease 8-10% for every minute to pass. As a matter of fact, these situations strongly create the need for trained layman rescuers and a coordinated community response.

It has been estimated that mortality from cardiovascular diseases (CVD) are almost three times more frequent in undeveloped Latin- American (LA) countries that developed countries, and because there were not enough publish data regarding the difference in risk profile of the LA vs. non LA population, the investigators of the CRUCIAL Study planned a sub analysis that could compare the behavior of the proactive interventional strategy in Latin-American vs. Non Latin American countries, as well the differences in the risk profile of the Latin American subjects compare with the rest of the world population included in the study.

Cardiovascular Diseases

It is also important to remember that the real worldwide behavior of the physicians was to treat Hypertension and Dyslipidemia as separate entities instead to treat cardiovascular risk. And hence The ASCOT Trial in the lipid lowering arm shown a clear benefit in relative risk reduction in mobility and mortality we pretend to address the question trough the design of the CRUCIAL Study to compare in real life the relative reduction in calculated Framingham coronary heart disease risk when a multiple risk factor intervention strategy, based on single-pill amlodipine besylate/atorvastatin calcium was compared with usual care strategy in patients with hypertension and > 3 additional cardiovascular risk factors and base line cholesterol < 6.5 mmol/L and no coronary heart disease.